The Difference Between Therapy and Coaching

As a licensed therapist who recently became a certified coach, I am frequently asked to explain the difference between therapy and coaching. Sometimes I can’t tell if the enquirer is genuinely interested or merely being polite, so I have a few nutshell responses to offer before seeing where the conversation takes us.

“Therapy is about healing; coaching is about growth.”

“Therapy is how the past impacts the present; coaching is how the present impacts the future.”

“People come to therapy because they want something fixed. They come to coaching because they want something changed.”

and then the zinger, which is a blog topic in itself,

“People are willing to pay a lot more for coaching than they are for therapy.”

Of course the reality is much more nuanced than a nutshell response can provide, and the more I try to define it, the more slippery it becomes. But what I’ve mostly found is that where you’re from, what you grew up with and what you trained in has a lot to do with how you see it. 

If you’re from England or Canada where therapy was historically the preserve of the rich, the American and those with debilitating mental illnesses (I dare you to draw a Venn diagram), there’s not so much of a distinction. Coaches and counselors stepped into the vacuum to offer therapeutic-type interventions to the general public, while therapists got wind of motivational interviewing and reframe that had typically been the purview of the coaches. Diagnosing was – and still is – only offered only by psychiatrists (the ones with medical degrees) or psychologists trained in standardized assessments. And with the exception of a few sessions of Cognitive Behavioral Therapy offered at the doctors’ office, everyone else offers some combination of private-pay interventions to get you moving in a better direction, no matter what they call themselves.

In the US, however, it’s a different story. Here, therapy is considered part of the already-convoluted healthcare system, which means that national and state boards step in to protect the public from anyone who might seek to offer services without the right credentials. The result is a tangled bureaucratic web of licensure and state-line turf-wars. Insurance companies then join the fray and argue about who, what and how many sessions they won’t cover, providing a catch-22 for therapists who are bound by state guidelines not to allow third parties to influence their treatment. The result is a mess of unnecessary diagnoses, paperwork and way too much fear-based practice, which is then seized on by lawyers who need therapy records for their divorce cases and personal injury claims. At which point you can bet your bikini that those clients who minimized their symptoms to avoid a big diagnosis are disappointed that they didn’t get the big-ass diagnosis after-all, because they’re suing someone for something bad.

If it sounds exhausting, I can assure you, it is. For several months I’ve had a recurring dream where I’m at a conference and someone invites me to participate in a great opportunity, and I go to grab my bag so I can join them. But I have so many purses and backpacks and plastic bags and – in one dream, even a hat and a cat carrier – that no matter how hard I try, I can’t consolidate them all fast enough. By the time I find a temporary solution – like throwing everything in a shopping cart – everybody’s left without me, and I can’t get the shopping cart down the stairs anyway. 

It doesn’t take a psychoanalyst to interpret what’s going on in my head, and you may be wondering why I still hang on to therapy licensure when it represents so much baggage for me. In truth, I do think about letting it go from time to time, but the reason I haven’t is the same reason that I stay in fancy hotels when I travel. If I’m going to go to a strange, challenging and possibly scary place, I want to know that I’m going to be safe and well taken-care of. And that’s how most of my clients feel too, especially when I’m digging into their past issues of trauma and deep-seated shame.

For all of my griping, the truth is that therapy licensure brings with it some meaningful assurances. Although some coach training programs are pretty rigorous (and CTI, the program that certified me, is one of them), a person doesn’t have to complete – or even start – a training program to call themselves a coach. A therapist licensed in any state however, has been through an accredited graduate school program, post-degree supervision, national and state exams and must complete continuing education hours to ensure they stay up-to-date. While therapists may choose not to treat certain diagnoses in their practice, they’re still very adept at spotting them, which can help a prospective client find the help they need. And, despite the shortcomings of health insurance, it does (occasionally) enable access to therapy for more people than would be able to afford it privately.

Of course state licensure isn’t entirely foolproof – there are some terrible therapists out there just as there are some truly incredible coaches. But as a general rule, it’s a bonus and a privilege to work with someone whose state is willing to vouch for their level of education and standard of care, as Minnesota is for mine.

Therapist or coach?

I’m neither, and I’m both.

Whatever you call me, it’s the relationship between us that brings the healing, the magic and the growth. 

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EMDR therapy explained

All living bodies are predisposed towards healing. If we have a cut or a bruise or even a sprained ankle, our bodies will usually be able to repair themselves, whether or not we understand how. Sometimes, with more serious injuries, our bodies need help to start the healing process – wounds need to be cleaned; stitches, splints or plaster-casts may need to be applied; physical therapy may be necessary. Yet even with all the astounding facilitation that modern medicine provides, it is still our own bodies that do the actual healing.

It is a long held belief that psychological wounds take much longer to heal than physical wounds. Bruising sustained during an assault may disappear within a month, while the memory of that assault and associated fear may remain with a person for a lifetime. Yet treatment with EMDR suggests that this does not have to be the case. The brain too, it seems, is predisposed to heal itself as quickly as the body does – but it some cases it needs help facilitating the healing process. EMDR provides that help.

The brain’s information processing system

The brain is such a complex organ and there is much that we do not understand about it. But we do know that sleep is highly important to our wellbeing, and that there are different cycles of sleep. One of these cycles is known as REM (Rapid Eye Movement) sleep. Research suggests that this is the brain’s means of processing, filing and storing information for later retrieval. Indeed, several studies on both humans and animals have shown that if a subject is deprived of REM sleep after learning a new skill, the skill will no longer be retained*. In short, it seems that all the information and experiences of our everyday lives are processed and integrated into our overall life story during REM sleep – whether we remember dreaming or not.

The problem of trauma

Yet some data is too disturbing or upsetting to be properly processed by REM sleep – which is often the cause of nightmares that wake us before processing is finished. Such data can include major traumas – such as a violent assault, a car accident or a hurricane – or it can include a series of smaller life events that serve to undermine our sense of wellbeing, security and peace with the world. Other data never actually makes it to the Thalamus – the part of the brain responsible for taking all of our sensory information and weaving it into an integrated, cohesive experience. Instead, the data exists in the form of unconnected, fragmented images, sounds or sensations that occurred right before the traumatic event, which become the “cues” that alert the brain to potential danger in the future. If one of these cues is triggered by something similar, the thoughts, feelings and bodily sensations associated with the past can come flooding back, causing us to overreact to the current situation.

In many cases, we may not associate the original event with what is happening in the present, but will find ourselves suddenly overwhelmed by feelings of hopelessness, powerlessness or fear. We may react in ways that are inappropriate and damaging – by “losing it” with an incompetent boss, a rude child or an unsupportive partner – not  understanding why they have such an effect on us. We may find ourselves paralyzed with fear by the thought of public speaking, flying or visiting a doctor’s office. Someone in our lives might seem to bring out the worst in us, causing us to behave in ways that we dislike but can’t seem to do anything about. Any of these situations could be the result of unprocessed, improperly stored data from our past that needs reprocessing.

What EMDR does

By using eye movements that mimic REM sleep, EMDR stimulates the brain’s natural processing mechanism so that the fragments of disturbing material from the past can be accessed, processed and integrated into a cohesive experience and then into the overall life story. In the case of a recent, single incident trauma such as a mugging or a hurricane that occurred in the past couple of months, the disturbance can usually be cleared up within a few sessions of EMDR. When there are a number of traumatic incidents, or the same trauma was repeated multiple times (as in the case of physical or sexual abuse), EMDR therapists create a “target sequence plan” that lists all of the traumatic events and memories to be covered in the course of therapy. Generally, by starting with the first chronological event on the list and moving to the worst, the disturbance level of all of the memories on the plan will be brought down significantly, again enabling improvements relatively quickly.

At the end of treatment with EMDR, memories still remain, but feel distant and inconsequential. Most importantly, they are no longer associated with the emotions and bodily sensations that can be so debilitating in the present, and the cues that caused the over-reaction will be desensitized. Nightmares and flashbacks should clear up all together, and it’s not unusual for clients to report a significant decrease in physical ailments such as aches and pains, coughs, colds and allergies. Most importantly, clients typically find they have a new sense of peace with the world and with themselves which their loved ones can’t help but notice.

 

*Karni, A., et al. (1992), cited by Shapiro F. and Silk Forest, M. (2004). EMDR: The Breakthrough Eye Movement Therapy for Overcoming Anxiety, Stress and Trauma. New York, NY: Basic Books, 92.

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Tapping videos

TFT seems complex at first glance, but most people choose one or two favorite routines and learn them after just a few times through. On this page, you can download instructions as a PDF file or watch a video of Jane walking you through the process.

Complex Trauma Complete algorithm

This is Jane’s favorite algorithm because it covers a multitude of emotions including sadness, grief, anxiety, anger, guilt and shame. Tapping the sequence will bring down the discomfort associated with traumatic or shaming memories, infuriating events, and disturbing images that have lodged themselves in the brain. Open PDF instructions.

 

Physical Pain algorithm


The physical pain algorithm is much shorter and can be used to reduce pain or other bodily sensations that are causing distraction or distress. It also works well for EMDR headaches – the discomfort in the front of the forehead that sometimes follows a session of trauma processing. Open PDF instructions.

Please Note:
The TFT information given on this website is taken from materials provided by Jill Strunk, Ed.D., LP., TFTdxVT in her training for therapists:
Rapid Resolution for Intractable Problems, 19 September, 2009. Permission has been given for the use of her materials as a resource for clients of Jane McCampbell, MA, LMFT. Permission has NOT been given for general download or distribution. Please do not reproduce or copy this material in any form. For published information on TFT, please reference Dr Roger Callahan’s book, Tapping the Healer Within (2002), available from Amazon, or contact Roger Callahan’s organization, Callahan Techniques, directly.